Provider Demographics
NPI:1083819155
Name:THOMPSON, SUSAN MARILYN (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARILYN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E 51ST ST APT 3X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2233
Mailing Address - Country:US
Mailing Address - Phone:718-763-5289
Mailing Address - Fax:
Practice Address - Street 1:1795 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2866
Practice Address - Country:US
Practice Address - Phone:212-289-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400918-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health